Receipt of Colonoscopy Following Diagnosis of Advanced Adenomas: An Analysis within Integrated Healthcare Delivery Systems

Chubak, Jessica; McLerran, Dale; Zheng, Yingye; Singal, Amit G.; Corley, Douglas A.; Doria–Rose, V. Paul; Doubeni, Chyke A.; Kamineni, Aruna; Haas, Jennifer S.; Halm, Ethan A.; Skinner, Celette Sugg; Zauber, Ann G.; Wernli, Karen J.; Beaber, Elisabeth F.

doi:10.1158/1055-9965.epi-18-0452

Cited by 19 publications

(23 citation statements)

References 18 publications

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“…The high rates of colonoscopy follow-up after a positive FIT result are consistent with previous reports of FITpositive follow-up in this organized programmatic screening setting 21 and are higher than those reported in other settings, [22][23][24] including a safety-net hospital system catering to the underserved. 23 The high rates of follow-up were achieved through an organized screening program that included prompt communication of positive results to patients and their physicians, colonoscopy capacity and preferential triage of patients with a positive FIT result, active outreach to patients to promptly schedule colonoscopy after a positive FIT result, and centralized tracking of and follow-up for examination completion.…”

Section: Discussionsupporting

confidence: 89%

Early Screening of African Americans (45–50 Years Old) in a Fecal Immunochemical Test–Based Colorectal Cancer Screening Program

et al. 2020

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BACKGROUND & AIMS: Some guidelines recommend starting colorectal cancer (CRC) screening before age 50 years for African Americans, but there are few data on screening uptake and yield in this population. METHODS: We performed a prospective study of fecal immunochemical test (FIT) screening among African American members of the Kaiser Permanente Northern California health plan. We compared data from African American members screened when they were 45-50 years old (early screening group) in 2018 with data from previously unscreened African American, white, Hispanic, and Asian/Pacific Islander health plan members who were 51-56 years old. Screening outreach was performed with mailed FIT kits. Logistic regression models, adjusted for sex, were used to evaluate differences among groups in screening uptake, colonoscopy follow-up of abnormal test results, and test yield. RESULTS: Among 10,232 African Americans in the early screening group who were mailed a FIT, screening was completed by 33.1%. Among the 4% with positive test results, 85.3% completed a follow-up colonoscopy: 57.8% had any adenoma, 33.6% had an advanced adenoma (adenoma with advanced histology or polyp 10 mm), and 2.6% were diagnosed with CRC. African Americans in the early screening group were modestly more likely to have completed screening than previously unscreened African Americans, whites, and Hispanics 51-56 years old. The groups did not differ significantly in positive results from the FIT (range, 3.8%-4.6%) and more than 74% received a follow-up colonoscopy after a positive test result. The test yields for any adenoma (range, 56.7%-70.7%), advanced adenoma (range, 20.0%-33.6%), and CRC (range, 0%-7.1%) were similar. CONCLUSIONS: Proportions of African Americans who participated in early (aged 45-50 years) FIT screening and test yield were comparable to those of previously unscreened African Americans, whites, Hispanics, and Asian/ Pacific Islanders who were 51-56 years old.

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Section: Discussionsupporting

confidence: 89%

Early Screening of African Americans (45–50 Years Old) in a Fecal Immunochemical Test–Based Colorectal Cancer Screening Program

et al. 2020

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“…11 As a significant proportion of patients with high-risk adenomas will either not undergo any surveillance or undergo surveillance later than guidelines recommend, the importance of complete adenoma resection should be given similar attention as achieving a high ADR. [54][55][56] Furthermore, recent revisions to colonoscopy surveillance guidelines include longer surveillance intervals than previously recommended; once these new surveillance intervals are implemented, complete adenoma resection will become even more important. 54,[57][58][59][60] Quality improvement initiatives have had great success in recent years in improving colonoscopy quality with regard to cecal intubation rates and ADRs.…”

Section: Discussionmentioning

confidence: 99%

Rates of Incomplete Resection of 1- to 20-mm Colorectal Polyps: A Systematic Review and Meta-Analysis

Djinbachian¹,

Iratni²,

Durand³

et al. 2020

Gastroenterology

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This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e19. Learning Objective: Upon completion of this CME activity, successful learners will be able to describe key colonoscopy quality metrics and employ proper polypectomy techniques in different clinical situations. BACKGROUND & AIMS: Incomplete resection of neoplastic colorectal polyps can result in postcolonoscopy colorectal cancer. We performed a systematic review and meta-analysis to determine the incomplete resection rate (IRR) of colorectal polyps and associated factors. METHODS: We searched MED-LINE, EMBASE, EBM Reviews, and CINAHL to identify full-text articles that reported IRRs of polyps 1 to 20 mm, published until March 2019. Exclusion criteria were studies of inflammatory bowel disease cohorts, referrals for difficult polypectomy, polyp sizes larger than 20 mm, and endoscopic submucosal resection and/or dissection as polypectomy approaches. IRRs were calculated based on findings from biopsies taken at polypectomy sites or assessments of margins of resected polyps. The primary outcome was IRR for snare removal of polyps 1 to 20 mm. Secondary outcomes included IRR for polyps 1 to 10 mm and 10 to 20 mm, IRR for hot and cold snare removal of polyps 1 to 10 mm and 10 to 20 mm, IRR of snare removal with or without submucosal injection, and IRR for forceps and cold snare removal of polyps 1 to 5 mm. RESULTS: We identified 6148 reports and used 32 studies, with a total of 9282 polyps, in our quantitative analysis. The IRR for snare removal of polyps 1 to 20 mm was 13.8% (95% confidence interval [CI] 10.3-17.3; 13 studies, 5128 polypectomies). IRRs were 15.9% for snare removal of polyps 1 to 10 mm (95% CI 9.6-22.1; 9 studies, 2531 polypectomies) and 20.8% for snare removal of polyps 10 to 20 mm (95% CI 12.9-28.8; 6 studies, 412 polypectomies). The IRR for hot snare removal of polyps 1 to 10 mm was 14.2% (95% CI 5.2-23.2) vs 17.3% for cold snare polypectomy (95% CI 14.3-20.3). The IRR for forceps removal of polyps 1 to 5 mm was 9.9% (95% CI 7.1-13.0) vs 4.4% for snare polypectomy (95% CI 2.9-6.1). CONCLUSIONS: In a systematic review and meta-analysis, we found that colorectal polyps 1 to 20 mm are frequently incompletely resected, and that risk increases for polyps 10 mm or larger. There is no difference in IRRs of cold vs hot snares for polyps 1 to 10 mm. Snare polypectomy should be used over forceps for polyps 1 to 5 mm.

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“…In a retrospective cohort study exploring surveillance patterns in community practice, Schoen et al found low rates of surveillance uptake at 3 years for patients diagnosed with an aTA (30.7%) or ≥ 3 non-advanced adenomas (19.5%) 8 . Across several large integrated health systems, Chubak et al reported similarly low uptake at 3 years for patients diagnosed with ≥ 3 adenomas and/or ≥ 1adenoma with villous/tubulovillous histology (10.2–30.9%) 9 . Akin to our findings, both studies noted a sudden rise in surveillance uptake in the immediate wake of the surveillance due date, and subsequent studies have shown increases in surveillance colonoscopy up to 6 years after HRA diagnosis, well after the recommended 3-year interval 8 , 11 , 13 .…”

Section: Discussionmentioning

confidence: 99%

“…In a large retrospective cohort within community practice, only 30.7% of patients diagnosed with advanced tubular adenoma (aTA; defined by having at least one TA ≥ 1 cm, TA with tubulovillous/villous histology, or TA with high-grade dysplasia) and 19.5% of patients with 3 or more non-advanced adenomas completed surveillance by 3 years 8 . In a multisite cohort spanning 4 regional health systems, surveillance uptake at 3.5 years in patients with either 3 or more adenomas and/or 1 or more adenomas with tubulovillous/villous histology ranged between 18.3 and 59.5% 9 .…”

Section: Introductionmentioning

confidence: 99%

“…Ample efforts in public health and clinical research address suboptimal CRC screening rates and evaluate interventions to increase screening among individuals at average-risk for CRC; however, strategies to reduce ongoing risk following diagnosis of an adenoma with high-risk features remain sparse in CRC prevention and control 10 . Non-modifiable predictors for timely surveillance including younger age, having a first-degree relative with CRC, and having ≥ 3 adenomas 8 , 9 , 11 , but less is known about modifiable patient-, provider-, and health-system factors that could serve as potential targets for interventions to increase timely surveillance uptake.…”

Section: Introductionmentioning

confidence: 99%

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Gastroenterology visitation and reminders predict surveillance uptake for patients with adenomas with high-risk features

Myint

Corona

Yang

et al. 2021

Sci Rep

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Individuals diagnosed with colorectal adenomas with high-risk features during screening colonoscopy have increased risk for the development of subsequent adenomas and colorectal cancer. While US guidelines recommend surveillance colonoscopy at 3 years in this high-risk population, surveillance uptake is suboptimal. To inform future interventions to improve surveillance uptake, we sought to assess surveillance rates and identify facilitators of uptake in a large integrated health system. We utilized a cohort of patients with a diagnosis of ≥ 1 tubular adenoma (TA) with high-risk features (TA ≥ 1 cm, TA with villous features, TA with high-grade dysplasia, or ≥ 3 TA of any size) on colonoscopy between 2013 and 2016. Surveillance colonoscopy completion within 3.5 years of diagnosis of an adenoma with high-risk features was our primary outcome. We evaluated surveillance uptake over time and utilized logistic regression to detect factors associated with completion of surveillance colonoscopy. The final cohort was comprised of 405 patients. 172 (42.5%) patients successfully completed surveillance colonoscopy by 3.5 years. Use of a patient reminder (telephone, electronic message, or letter) for due surveillance (adjusted odds = 1.9; 95%CI = 1.2–2.8) and having ≥ 1 gastroenterology (GI) visit after diagnosis of an adenoma with high-risk features (adjusted odds = 2.6; 95%CI = 1.6–4.2) significantly predicted surveillance colonoscopy completion at 3.5 years. For patients diagnosed with adenomas with high-risk features, surveillance colonoscopy uptake is suboptimal and frequently occurs after the 3-year surveillance recommendation. Patient reminders and visitation with GI after index colonoscopy are associated with timely surveillance completion. Our findings highlight potential health system interventions to increase timely surveillance uptake for patients diagnosed with adenomas with high-risk features.

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Receipt of Colonoscopy Following Diagnosis of Advanced Adenomas: An Analysis within Integrated Healthcare Delivery Systems

Cited by 19 publications

References 18 publications

Early Screening of African Americans (45–50 Years Old) in a Fecal Immunochemical Test–Based Colorectal Cancer Screening Program

Early Screening of African Americans (45–50 Years Old) in a Fecal Immunochemical Test–Based Colorectal Cancer Screening Program

Rates of Incomplete Resection of 1- to 20-mm Colorectal Polyps: A Systematic Review and Meta-Analysis

Gastroenterology visitation and reminders predict surveillance uptake for patients with adenomas with high-risk features

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